Rehabilitative approach in early stages of multiple sclerosis

Abstract

Patients with multiple sclerosis (MS) since the earliest stages experiencing motor and cognitive problems, such as lower motor fluidity, reduced attention spans, memory impairments. The progressive loss of integration ability of the central nervous system resulting in a disconnection damage. First affected are fast systems with high level of integration. “Dual tasking” often leads to a poorer performance. Aim of the study is to verify the value of early rehabilitation in reducing the impact of these symptoms on daily living. We conducted a case-control study including 15 patients with EDSS < 3, divided into three groups: 5 underwent 10 sessions of adapted physical activity (APA); 5 had 10 cognitive-motor training sessions (individual rehabilitation project-IRP), 5 not underwent rehabilitation treatment (control). Patients had initial and final motor-cognitive assessments using Berg Balance Scale (BBS), Ten Meter Walking Test (TMWT) at different speeds and performing a cognitive task (Word List Generation-WLG), Brief Repeatable Battery of Neuropsychological Tests (BRB-NT), Trail Making Test (TMT) and Digit Span. TMWT final evaluation showed variations in IRP and APA. The number of words generated in usual and quick speed, not changed in Control, was reduced in APA, increased in IRP. BBS score variation was statistically significant in IRP and APA (IRP initial median score: 52, final median score: 55). At BRB-NT, after cognitive training, results a significant improvement in IRP ( t -test: p 0,005). IRP and APA show a greater ability in balance control and global fluidity; IRP has better performance in “dual tasking”, probably related to an exercise focused on individual specific impairments. These data support the value of individualized rehabilitation treatment, since the early stage of the disease, moreover APA could represent a good tool in the maintenance phase.